Revisiones_bibliográficas TyO

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lunes, 23 de enero de 2017

Enero 23, 2017. No. 2578

Dexmedetomidina versus midazolam en sedación para procedimientos. Revisión sistemática de eficacia y seguridad

Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety.

Barends CR1, Absalom A1, van Minnen B2, Vissink A2, Visser A2.

PLoS One. 2017 Jan 20;12(1):e0169525. doi: 10.1371/journal.pone.0169525. eCollection 2017.

Abstract

OBJECTIVES: To systematically review the literature comparing the efficacy and safety of dexmedetomidine and midazolam when used for procedural sedation. MATERIALS AND METHODS: We searched MEDLINE, EMBASE and COCHRANE for clinical trials comparing dexmedetomidine and midazolam for procedural sedation up to June 20, 2016. Inclusion criteria: clinical trial, human subjects, adult subjects (≥18 years), article written in English, German, French or Dutch, use of study medication for conscious sedation and at least one group receiving dexmedetomidine and one group receiving midazolam. Exclusion criteria: patients in intensive care, pediatric subjects and per protocol use of additional sedative medication other than rescue medication. Outcome measures for efficacy comparison were patient and clinician satisfaction scores and pain scores; outcome measures for safety comparison were hypotension, hypoxia, and circulatory and respiratory complications. RESULTS: We identified 89 papers, of which 12 satisfied the inclusion and exclusion criteria; 883 patients were included in these studies. Dexmedetomidine was associated with higher patient and operator satisfaction than midazolam. Patients receiving dexmedetomidine experienced less pain and had lower analgesic requirements. Respiratory and hemodynamic safety were similar. CONCLUSIONS: Dexmedetomidine is a promising alternative to midazolam for use in procedural sedation. Dexmedetomidine provides more comfort during the procedure for the patient and clinician. If carefully titrated, the safety profiles are similar.

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Comparación de sedación con midazolam-ketamina versus propofol-fentanil durante endoscopía en niños

A comparison of sedation with midazolam-ketamine versus propofol-fentanyl during endoscopy in children: a randomized trial.

Akbulut UE1, Saylan S, Sengu B, Akcali GE, Erturk E, Cakir M.

Eur J Gastroenterol Hepatol. 2017 Jan;29(1):112-118.

Abstract

PURPOSE: We aimed to compare the efficacy and safety of midazolam plus ketamine versus fentanyl plus propofol combination administered to children undergoing upper gastrointestinal endoscopy (UGE) and to determine the most appropriate sedation protocol.

CONCLUSION: In children, UGE procedures can be quite comfortable when using the midazolam-ketamine combination. However, adverse effects related to ketamine were observed during recovery.

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Concentraciones plasmáticas de midazolam después de premedicación anestésica en la rutina clínica.

Midazolam plasma concentration after anesthesia premedication in clinical routine - an observational study : Midazolam plasma concentration after anesthesia premedication.

Steiner C1, Steurer MP2, Mueller D3, Zueger M4, Dullenkopf A5.

BMC Anesthesiol. 2016 Oct 24;16(1):105.

Abstract

BACKGROUND: Midazolam is commonly used as a pre-anesthesia anxiolytic. It`s elimination may not be fast enough for short procedures. In orally premedicated patients we obtained midazolam plasma concentrations at the end of surgical procedures and compared those to concentrations at anesthesia induction.

CONCLUSIONS: The elimination half-life of oral Midazolam can lead to higher plasma levels at the end of a short procedure compared to those at induction of anesthesia.

KEYWORDS: Anesthesia; Anxiolysis; Midazolam; Premedication

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